We have created a pretty mad world in some of our larger organisations. I am thinking especially of health and education, where bureaucracy and top-down control seem to have taken over – and that’s not just in the UK.

Over the Christmas period we had a visit from an old friend of my husband who is a General Practitioner in southern Germany. Prompted by my curious questioning, he began to overflow with stories about documentation gone mad. For example, after every patient visit, he now has to enter his diagnosis into a computer system by selecting from a long list of codes. He is also supposed to note whether each diagnostic code he selects is: (a) certain, (b) suspected or (c) can be excluded.

This system, he says, not only creates extra work but also encourages doctors to provide “invented” diagnoses. In other words, it distorts how they record a patient’s condition. The system originated in Australia, but “the Germans have perfected it”, he noted with a smile. The computer even offers blocks of text for cutting and pasting.

Documentation is not a bad thing in itself. But when taken to excess, it robs practitioners of time they could otherwise be spending in conversation with people. Our GP friend explained that he has always taken proper patient histories/stories (same word – Geschichte – in German). He also continues to handwrite his notes, as in his view patients prefer their doctor not to be glued to the computer.

As I reflected on his words, it occurred to me that those who put in place these systems implicitly undervalue health professionals’ experience, memory and ability to make connections and patterns.

How has this madness come about? As always, there are multiple influences at work. The one I immediately think of, given my interest in uses of writing, is that many people simply do not understand, or stop to think about, how written communication works – and how it can actually hinder communication. Managers and policy makers in particular seem to accept without question the value of detailed documentation. Additionally, they are often remote and disconnected from what is happening on the ground – they don’t and can’t be present to the human exchanges between patients and health professionals, for instance. And of course all the bureaucratic rules and procedures are reinforced and perpetuated by the inevitable power relations among practitioners, and between practitioners and managers or policy makers.

After talking to our doctor friend, I happened to be reading a book called “Wilful Blindness” by Margaret Heffernan. In it, the author describes how most people in organisations – even when they sense or know there is something wrong – tend to stay silent. She provides copious examples (in banking, in the army, in private companies, and also in the NHS) of people following orders, clinging to convictions or submitting to groupthink. And on top of all that, many work long hours and are under relentless pressure to pursue efficiency and cut costs. These conditions make them even more likely to develop tunnel vision and just do what they are told.

In the face of what he sees as senseless bureaucracy, what does our German GP do? “Resignation” was the word he used. But he did nevertheless point to some small acts of subversion. For example, having handwritten his patient note, he only enters the absolute minimum information (the diagnostic codes) into the computer. Or he refuses to sign what he sees as time-wasting, superfluous documents presented to him by staff in the care home that houses some of his patients. He knows that the nurses there spend hours documenting everything in great detail, and presumably therefore less time really caring for patients. Why should he sign a piece of paper just because the computer system adopted by the home spits out a whole page detailing each patient’s medication?

These small subversive acts make our friend unpopular with some of his colleagues. But he works in a single-handed practice and only has a few years left before he retires, so he can afford to risk being the odd-one-out.

No doubt much of what he experiences is equally in evidence here in the UK.

What would it take for this bureaucratic madness to change – a new generation of doctors willing to challenge and question? So far, according to our friend, junior doctors in Germany show little sign of starting a revolution. If anything they are more compliant than his contemporaries.

He also regrets that the trainee doctors he comes across are no longer taught how to take proper patient histories and are less likely than their older colleagues to examine patients physically. Instead, they rely on technological scans and tests. People going through medical education today also get fewer opportunities to see patients than he did. This is because (mercifully perhaps) they no longer work such long hours.

Perhaps one day the current culture of bureaucratic control will just become outmoded. People may decide it has run its course or that it has simply generated too many distortions. I suspect it will take not only some very obstinate and courageous individuals but also some kind of collective rebellion.